Factors associated with glycaemic control in patients with diabetes mellitus: A systematic literature review

Abstract

Objectives To perform a systematic review search and critically review the empirical evidence concerning the factors affecting glycaemic control in patients with type 1 or 2 diabetes mellitus. Background Previous primary studies have investigated the factors associated with glycaemic control among patients with type 1 or 2 diabetes, but attempts to amalgamate these evidences have been methodologically limited. Hence, a robust review of the evidence is essential to explore factors that can be addressed to promote good glycaemic control in patients with diabetes. Design Mixed‐method systematic review using the Preferred Reporting Items for Systematic review and Meta‐Analysis 2009 flow diagram, integrating evidence from qualitative and quantitative studies (see Supporting Information File S1). Methods A systematic review of the literature published between 2006–2017 was conducted in seven electronic databases (CINAHL, MEDLINE, Scopus, EMBASE, PsycINFO, PubMed and ScienceDirect) using the search terms “diabetes mellitus,” “glycemic control,” “self‐concept,” “knowledge,” “self‐efficacy,” “empowerment,” “race,” “ethnicity,” “duration,” “medication,” “obesity” and “comorbidity.” Results A total of 1,582 articles were initially retrieved, and 24 of these articles were included in this systematic literature review. The overall empirical evidence suggested that higher socio‐economic status, greater dietary knowledge, and higher self‐efficacy and empowerment improve glycaemic control among patients with diabetes mellitus. Conclusions This review presented the factors associated with glycaemic control that may pose significant socio‐economic problems to most nations worldwide and impede development nationally, regionally and even globally. Greater emphasis needs to be placed on implementing lifestyle changes on a societal level to stem the tide of the epidemic. Relevance to Clinical Practice There is a need to implement self‐management initiatives, that incorporate dietary knowledge, to empower patients with diabetes in their own care. Future public health policy must be geared towards increasing the capability of dealing with the rising incidence of diabetes and implementing primary prevention.

Participation in structured diabetes mellitus self-management education program and association with lifestyle behavior: results from a population-based study

“…However, a meta-analysis of 21 studies on this topic showed a significant improvement of self-efficacy after DSME participation after 6 months,33 indicating that participant’ self-efficacy is increased by DSME participation. Increased self-efficacy seems to be significantly associated with a better glycemic control,34 but more research is needed on how self-efficacy influences glycemic control.…”

Use of a diabetes-specific nutritional shake to replace a daily breakfast and afternoon snack improves glycemic responses assessed by continuous glucose monitoring in people with type 2 diabetes: a randomized clinical pilot study

“…Behavioral research cites a greater preoccupation with food, lack of control over eating high-carbohydrate foods, and food cravings as significant barriers to successful diabetes self-management. [23][24][25][26] Replacing a daily breakfast and afternoon snack with a DSNS can lead to increased overall feeling of control over food choices, perhaps by reducing the uncertainty of eating on glycemic responses. The composition of the DSNS (rich in protein, low glycemic index-carbohydrates and fiber) is more likely to induce changes in gastrointestinal hormones (eg, ghrelin, peptide YY (PYY) and GLP-1) which are known to activate selected corticolimbic regions in the brain typically associated with mood, cognitive function, and food cravings.…”

Lifestyle factors, self-management and patient empowerment in diabetes care

“…Empowerment is a process whereby an individual has greater ability to determine their decisions and self-care activities for their health. 27 In people with DM it is important to have sufficient diabetes-related knowledge in order to increase patients' empowerment. [28][29][30] Several studies have shown that empowerment can reduce the level of HbA1c, endorse behavioural changes, improve psychological status and increase health literacy, self-care and control.…”

“…34 Studies have shown that improved dietary knowledge is associated with better glycaemic control because persons well-equipped with dietary knowledge tend to make informed decisions that are appropriate to their health condition. 27 This is considered to be very important for chronic health diseases as recognised by the World Health Organization (WHO), while keeping or improving persons' quality of life. 35 A patient-centred empowerment-based programme can improve the quality life of persons with poorly controlled DM.…”